Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Background: Galloping economic growth and reform in China in the past 30 years has led to dramatic social changes. Attitudes towards sex and sexual behaviour have changed, and premarital sex has become more acceptable. The methods of contraception have changed, and the use of highly effective or long-acting contraceptive methods tends to be decreasing, especially in urban areas. Abortion is commonly used to end unintended pregnancy. The aim of this study was to survey the current situation of induced abortions in selected hospitals in 30 provinces in China.

Methods: This cross-sectional study was conducted in 295 randomly selected hospitals in 30 Chinese provinces between April and August, 2013. We collected data using a questionnaire filled by the abortion service providers for all women seeking abortion within 12 weeks of pregnancy during a period of two months. The information included self-reported demographic and economic characteristics, history of induced abortion, and use of contraception. The characteristics of women were summarised with counts (percentages) for categorical variables; mean (SD) and range for age of women. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium.

Findings: 79 174 women participated in the study (mean age 28∙9 years (SD 1∙7; range 13–58), of whom 27 134 (35%) were undergoing a first induced abortion, 28 637 (37%) a second abortion, and 22 682 (29%) a third or subsequent abortion. About a third of participants (31%) were not married and more than half (61%) were not local residents. The primary reasons for the unintended pregnancy were contraception failure (50%) and non-use of contraception (44%).

Interpretation: This is the first nationwide large-scale study in 30 provinces to show that repeated induced abortion is high in China. A family planning programme for young and unmarried people is urgently needed to improve their access to information, advice, and services about contraception and to reduce unintended pregnancies and repeated induced abortion.

Funding: The European Commission (EC) under the Seventh Framework Programme (FP7), project number 282490.